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Improving Care Coordination with Nationwide Data Exchange
Session #40, February 12, 2019
Arthur Lauretano, Chief Medical Officer, Circle Health
Jitin Asnaani, Executive Director, CommonWell Health Alliance
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Arthur M. Lauretano, MD, MS, FACS
Has no real or apparent conflicts of interest to report.
Jitin Asnaani
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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Barriers to nationwide interoperability today
How physicians are gaining access
A clinician’s perspective on data exchange
Enabling better coordinated care
Agenda
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Describe the barriers that hinder scalable, nationwide,
vendor-neutral interoperability today
Identify how physicians are gaining immediate access to
relevant patient information to improve patient care
Explain how better coordinated care can reduce tests, time
and costs as well as improve outcomes
Learning Objectives
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Barriers that hinder scalable,
nationwide, vendor-neutral
interoperability today
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The average person sees more than
18 providers in their lifetime
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And each provider has their own EHR(s)
and other clinical data sources
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Patients believe that their physicians
have access to all their health data
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But we all know the reality: Health data
information is still very siloed
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Competing priorities:
Within the government
Across the health IT vendor community
At the Provider Organization level
At the Physician level
Few tightly-constrained standards for data sharing and patient
matching
Most data sharing agreements are either at a regional or local
level or a provider-to-provider single connection
So what is standing in the way of
nationwide health data exchange?
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Current interoperability approaches
simply don’t scale
Community
Hospital
IDN
Pharmacy
Lab
Post-Acute
Specialist
PCP
Clinic
In this example alone, 28 distinct
point-to-point interfaces
Organizations are forced to create
contract-by-contract interoperability
between local IT systems
Regional “networks” achieve only
regional results
U.S. Census Bureau (2018):
the percentage of people that
move every year equates to
14% of the population (~40M)
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Ask patients to
remember their
clinical history
Request a fax+
Care Coordination is too dependent on
the patient and on archaic technology
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How physicians are gaining immediate
access to relevant patient information
nationwide
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Ask patients to
remember their
clinical history
Know where
patient has
been
Request a fax
Get the data
within the
workflow
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We are solving a hard problem
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We created a person-centered network
CommonWell Services
1. Enroll individuals in the network
2. Find their records
3. Match and Link their records
4. Broker queries and responses
5. Notify when patients have
encounters
1. Enroll individuals in the network
2. Find their records
3. Match and Link their records
4. Broker queries and responses
5. Notify when patients have
encounters
EHR
EHR
EHRHIT
HIT
HIT
EHR HIT
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The network is live and connected
across the nation
Acute Ambulatory
Patient
Access
Home Health
Critical
Access
Rehab/LTC
11,000+ provider sites
45M+ enrolled individuals
20M+ patient records retrieved
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We have partnered with Carequality to provide
connectivity beyond our network
Sequoia Project and
CommonWell to explore
collaboration opportunities in the
future
CommonWell to implement
Carequality Directed Query
specification
Basic version of CommonWell
Record Locator Service (RLS) to be
available to Carequality
Implementers
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CollaborationCollective Success
Together, members and participants
from both organizations represent:
90%
of acute EHR market
60%
of ambulatory EHR market
Source: KLAS and SK&A, a Cegedim Company
2016 Hospital EMR Market Share, May 2016. © 2016 KLAS Enterprises, LLC. All rights reserved. www.KLASresearch.com
“Physician Office Usage of EHR Software” SK&A. February 2017.”
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We are preparing for Federal Regulation
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From a Clinician’s Perspective
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Lowell is the 4
th
largest city in
the Commonwealth of
Massachusetts
Lowell General merged with
Saints Medical Center in 2012
to form 2
nd
largest community
hospital in the State
8
th
largest hospital in the state
HIMSS Stage 6 on the EMR
Adoption Model
Received Magnet Recognition
for quality patient care
Who We Are
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About Circle Health
3,500+
associates
2 hospitals & 18
ambulatory clinics
280,000 + annual
annual outpatient
visits
396 Beds
2,269 annual
births
660 physicians
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Circle Health /
Lowell General Hospital
Tufts Medical Center
Melrose / Wakefield Hospital
Lawrence Memorial Hospital
About Wellforce
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Circle Health EHRs / EMRs
Currently, 12 EMR/EHR Systems:
eClinicalWorks
Cerner
ComChart
SpringCharts
HDox
SuiteMed
SRS Freedom
athenahealth
Allscripts
ICS
Epic
AdvancedMD
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Desire to find specific
data
Push technology
yielding too much data
Delay in receiving
information, including
faxed information
The challenges our clinician’s faced
every day
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Truly patient-centered care
Timely access to information
Specificity of information
Simplicity of use
Easy, quick implementation
Consolidated view of the patient records
Immediately electronically available
Refined to the necessary information
Built right into your current software and
workflow
In less than 6 months, rolled out to
5,400+ facilities
Today’s reality with CommonWell
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CommonWell doesn’t store any of the clinical data
Enrollment/Consent Process is simple when incorporated into
standard check-in process
Patients actually get what they believe already exists provider
access to all of their records
Dispelling the myths
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How better coordinated care can
reduce time, tests and costs, as well
as improve outcomes
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For those patients whose records are not yet connected to
CommonWell:
Reduce time
30% of the
time asking office staff to
track down missing
patient
information
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Clinical Scenario: Thyroid Nodule
Patient sees specialist for thyroid
nodule identified on ultrasound;
referred from an outside system
If the ultrasound result is not easily
accessible, we would often repeat
it in our own system, possibly at a
different date, requiring additional
visits and copays
Delay in treatment, increased
patient anxiety, decreased patient
satisfaction
Reduce tests
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Clinical Scenario: Pediatric Cancer Scare
A recent 12 year-old-patient came to me
because her MRI report was interpreted
to the parents as showing an “abnormal
shadow” – PCPs office staff led family
to believe this was possibly cancer
Access to PCP note with MRI report
“Dental artifact from patient’s braces”
Obviated need for CT (cost and
radiation exposure) and resolved patient
and family anxiety
Reduce costs (and increased peace of mind)
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Clinical Scenario: Chest pain patient in the Emergency Room
55-year-old male with chest pain, new to the facility
CommonWell access to PCP notes:
Smoker, high cholesterol, father died at 52 - MI
55-year-old male with chest pain, new to the facility
CommonWell access to PCP notes:
Has been seen multiple times in the last two weeks, pulled a
muscle, but wanted to be assessed for CAD
Cardiology workup, including stress test, was negative
Improve processes and outcomes
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Access records from providers across the nation, not just locally
Electronic access, available immediately if/once linked
Better quality of care with reduced costs (appropriate tests, not
duplicate tests) Better Healthcare Value
Better Patient Experience
Contribution to the Triple/Quadruple Aim
Benefits of CommonWell
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It is critical to have access to a patient’s information regardless of
where prior care has occurred nationwide
Point-to-point connections are not scalable
Regional-only solutions can be valuable but have limited
visibility into the patient story
Nationwide connectivity is required to serve our large
mobile population
Takeaways
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With person-centric health information at the touch of your finger,
providers can achieve:
Better understanding of the patient context
Better coordinated care
Reducing tests, time and costs
Improving outcomes
Takeaways
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Arthur M. Lauretano, MD, MS, FACS
Chief Medical Officer
Circle Health
Arthur.Lauretano@circle-health.org
Jitin Asnaani
Executive Director
CommonWell Health Alliance
jitin@commonwellalliance.org
@jitin
Questions
Please complete the online evaluation (Session #40)